The UM Clinical Reviewer Senior Analyst promotes quality and cost-effective medical services through clinical review, applying Cigna clinical policies, national guidelines, and decision-support tools to determine authorizations. The role ensures timely completion of reviews to meet regulatory and contractual requirements while representing Cigna professionally.
Core Responsibilities:- Conduct utilization management reviews for medical necessity, appropriateness, and benefit coverage.
- Apply Cigna medical policies, MCG, ASAM, URAC standards, and clinical judgment.
- Identify cases requiring physician review and coordinate with Medical Directors.
- Initiate Case Management referrals as appropriate.
- Maintain compliance with HIPAA, regulatory rules, and internal quality standards.
- Participate in team meetings, quality audits, training, and workflow improvements.
- Support departmental initiatives, documentation accuracy, and performance metrics.
Qualifications:- Registered Nurse (RN) with multistate license in good standing. Compact license required.
- BSN preferred; Minimum 2 years RN experience in Cardiology, Oncology, ICU, or ER.
- Strong analytical, communication, and decision-making skills.
- Proficiency with Windows, Word, care management platforms, and documentation systems.
- Ability to manage multiple tasks, meet deadlines, and adapt to a fast-paced environment.
Competencies- Clinical Judgment & Decision Making
- Regulatory & Policy Compliance
- Communication & Collaboration
- Customer-focused Service Delivery
- Time & Workload Management
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
For this position, we anticipate offering an hourly rate of 31 - 52 USD / hourly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
At The Cigna Group, you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year, paid holidays, and leaves of absence. For more details on our employee benefits programs, click here.
